What Works for Women and Girls

found much lower rates of contraceptive use post partum (Nebrie et al., 2001; Desgrées-Du-Loû et al., 2002 cited in Balkus et al., 2007). (Gray III) (pregnancy, contraception,condom use, Kenya)Promising Strategies:3. Provision of clean water, fuel and formula to HIV-positive mothers who wish to practiceexclusive formula feeding can result in low postnatal rates of HIV transmission to infants.A study from Kenya enrolling HIV-positive mothers and their infants from 2006 to 2007found that an integrated water safety and PMTCT program was effective in preventingMTCT in infants after 6 weeks of age. Women enrolled in the PMTCT program receivedHAART, either for prophylaxis or for the mother’s health, infant feeding counseling,safe water education, free infant formula for women choosing not to breastfeed, chlorine-basedwater disinfectant, a water storage container, and home visits by a communityresource person. Of 144 mother-infant pairs included, 133 infants were tested forHIV at 6 weeks, 3 of whom tested positive. None of the 73 infants tested at 6 months ofage were HIV-positive (Lane et al., 2008). (Gray III) (PMTCT, infant feeding, Kenya)A review of clinical records from Rwanda enrolling HIV-positive mothers and theirinfants between 2005 and 2007 into an integrated PMTCT program combining cleanwater and formula provision, HIV and hygiene education, and healthcare services foundlow rates of postnatal HIV transmission and infant mortality after one year of followup.Replacement feeding was also monitored. Of 1,360 mother-infant pairs, 133 infantswere enrolled at birth (without prior breastfeeding) and eligible for one year of followup.Two infants tested HIV-positive at birth and 4 died before one year. At one year ofage, 92 infants were tested for HIV all of whom were HIV-negative (Rugira et al., 2008).(Gray V) (PMTCT, infant feeding, Rwanda)4. Exclusive breastfeeding results in lower rates of HIV transmission to the infant than mixedfeeding.A study in Zimbabwe from 1997 to 2000 of 2,060 infants born to HIV-positive mothersfound that solid foods or animal milks given to infants prior to three months of age wasassociated with a fourfold greater risk of postnatal transmission of HIV at six monthscompared with exclusive breastfeeding. The protective effects of early exclusive breastfeedingwere still significant at 18 months with a 61% reduction in postnatal transmissioncompared with mixed breastfeeding. Thus, the more strictly HIV-positive mothersare able to breastfeed exclusively, the lower the risks of HIV or death for their infants.More than two-thirds of all postnatal transmission of HIV occurred after six months.This is consistent with other studies from West Africa, South Africa and Tanzania andsupports early cessation of breastfeeding among HIV-positive women. Lastly, womenwith CD4 counts less than 200 cells/ul were five times more likely to transmit HIV260 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION